外伤性喉气管狭窄伴缺损及气管食管瘘的治疗

Treatment of traumatic laryngotracheal stenosis associated with giant defect and tracheoesphageal fistula

目的总结7例外伤性喉气管狭窄、巨大缺损并发气管食管瘘的治疗体会,探讨喉气管外伤后上述复杂后遗症的重建原则和手术方法。方法根据病变程度、范围和有无手术失败史,分别采取局部分层缝合、颈前带状肌或胸锁乳突肌加强修补气管食管瘘,采取黏膜下瘢痕切除、“Z”形减张缝合、栅栏状瘢痕松解、侧壁加高解除喉气管狭窄,采取颈前皮瓣或颈前皮瓣联合肋软骨支架修复颈前喉气管壁缺损。结果7例均获得满意呼吸、发音、进食功能,其中2例声门下病变成功保留了正常生理发音功能。结论喉气管狭窄、缺损、气管食管瘘同时存在时,应Ⅰ期治疗气管食管瘘+喉气管狭窄,Ⅱ期修补喉气管壁巨大缺损的原则。根据病变部位、范围不同,采取不同的手术方法。

Objective To study the surgical treatment and reconstruction principles of post-traumatic laryngotraeheal stenosis, giant defect and traeheoesphageal fistula by analysing the data of 7 cases who had been subjected to operative therapies. Methods Different operative method were used according to extent and degree of the affected lesions as well as operation failure history, such as Z-plasty, flap reconstruction and sternoeleidomastoid muscle mend.Results All the 7 cases attained satisfactory function in breathe, pronounce and swallow. Among them, the 2 cases suffered from subgiottie lesions successfully reserve the normal physio-pronouncation function. Conclusions When the laryngotraeheal stenosis, giant defect and traeheoesphageal fistula exist simultaneously, laryngotraeheal stenosis and traeheoesphageal fistula should be treated in 1-stage and laryngotracheal walls be mended in 2-stage. Different operative method should be considered according to extent and degree of the affected lesions.